5/8/2013. Tinnitus Population. The Neuromonics Sanctuary. relief. 50 Million individuals suffer from tinnitus

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1 Fitting the Sanctuary Device: A New Tinnitus Management Tool Casie Keaton, AuD, CCC-A Clinical Sales Manager casie.keaton@neuromonics.com Marta Hecocks, AuD, CCC-A Clinical Specialist marta.hecocks@neuromonics.com The Neuromonics Sanctuary Situational relief on demand for the mild to moderate tinnitus sufferer Customized acoustic signal Spectral modification Wide frequency stimulation Three hearing profiles Covers about 75% of patients User friendly setup Ready to go in minutes relief Engineered for maximum relief Tinnitus Population 50 Million individuals suffer from tinnitus 16 Million seek medical treatment for tinnitus 2 Million have severe, highly disturbing tinnitus 1

2 Sanctuary Fitting Training Format Candidacy considerations Getting to know the Sanctuary Fitting Profile Selection Counseling topics Device Usage Guidelines Follow-up Considerations Q & A Sanctuary Candidacy Considerations Symmetrical hearing Thresholds 20 dbhl between ears No indication of reactive tinnitus Patient history or Residual Inhibition test No significant psychological history associated with tinnitus Depression/anxiety/disturbance Lower end of disturbance scale TRQ score below 35 Score of zero on TRQ question #24 No indication of Hyperacusis Reactive Tinnitus Reactive tinnitus is an extreme and rare condition whereby a person s tinnitus is worsened after exposure to mild moderate levels of sound and this increase tends to last for more than a day Indicators which raise the possibility of Reactive Tinnitus: After RI testing, tinnitus is reported as exacerbated Suspected in people who a report of history of: over-use of hearing protection when not indicated have found that nothing reduces their awareness of tinnitus have had trials with other acoustic based treatments that clearly aggravated their tinnitus 2

3 Residual Inhibition Testing Standard Procedure: Binaural presentation Select NBN at Tinnitus Pitch Matched frequency Presentation level: db HL. Must be at least 10 dbsl Present NBN for 1 minute Additional presentation level procedure: Presentation level: 10 db HL above NBN MML Neurophysiology Auditory High Frequency Stimulation relief Emotional Calming music Targets the limbic system Customized Acoustic Signal High level of interaction Maximum neural stimulation Embedded Neural Stimulus Relief and reduced awareness during listening sessions 4 Musical Tracks Wide Frequency Stimulation to 12.5K relief 3

4 Getting to Know the Sanctuary Customized acoustic signal Spectral modification Three hearing profiles Covers about 75% of patients User friendly setup Ready to go in minutes Engineered for maximum relief Wide frequency stimulation relief Relief on demand Fitting Profile Selections Profile 1 Profile 2 Profile 3 Selection based on the patient s audiogram 10k and 12.5 k are included in the prescriptions, but not required 75% of audiometric thresholds should fall within fitting range What are the Sanctuary Fitting Profiles? Profile 1 4

5 What are the Sanctuary Fitting Profiles? Profile 2 What are the Sanctuary Fitting Profiles? Profile 3 Getting to Know the Sanctuary Headphone Port Software not required Buttons to highlight menu selections and operate device Micro-USB Port 5

6 Getting to know the Sanctuary Center Button Power on Power on Play/Pause Tracks Access Set-up Menu Access Clinician Menu Getting to Know the Sanctuary << or >> to: select Tracks Select desired time for sleep timer +/- to : adjust volume incrementally Select headphone Select fitting profile The Neuromonics Sanctuary Accessory Options Headphone Options Sony Sanctuary ships with this option Bose IE2 s Can be ordered If there are fit concerns Auxiliary Speaker JBL Bedside for sleep Desk for concentration relief 6

7 Headphones Standard Sony MDR-ED12LP Headphones Optional Bose IE2 Headphone Upgrade Fitting Profile Selection Guidelines Fitting Profile Selections Profile 1 Profile 2 Profile 3 Selection based on the patient s audiogram 10k and 12.5 k are included in the prescriptions, but not required 75% of audiometric thresholds should fall within fitting range 7

8 Fitting Profile Selection Left Right * 12.5* Fitting # Fitting # Fitting # For each frequency, circle the appropriate fitting range(s) Thresholds must be symmetrical, 20 db HL between ears at any frequency Choose the Fitting profile with the most circles selected 6 out of 8 frequencies if 250-8k are assessed 7 out of 10 frequencies if 10 k and 12.5 k are assessed Fitting Profile Selection * 12.5* Left Right Fitting # Fitting # Fitting # For each frequency, circle the appropriate fitting range(s) Thresholds must be symmetrical, 20 db HL between ears at any frequency Choose the Fitting profile with the most circles selected 6 out of 8 frequencies if 250-8k are assessed 7 out of 10 frequencies if 10 k and 12.5 k are assessed Counseling Topics and Device Usage Guidelines 8

9 Topics Counseling Topics Understanding tinnitus Sanctuary Mechanism of Action Sanctuary tinnitus management goals and expectations Tools to assist Patient specific assessment information Neurophysiology of Tinnitus slide Tinnitus Management Handbook Sanctuary User Manual Tinnitus Management Handbook Sanctuary User Manual Tinnitus Management Handbook Sanctuary Patient Expectation/Fitting Agreement General tinnitus management strategies Effective Device Usage Guidelines Additional Counseling Points: Relief contrast Contraindicated Activities Conditions that make tinnitus perception worse Tinnitus Management Handbook Tinnitus Management Handbook Sanctuary User Manual Tinnitus Management Handbook Sanctuary Tinnitus Management Goals and Expectations A tinnitus management tool used to provide relief from tinnitus perception while the device is being worn Designed to provide the patient with: a sense of empowerment and control help with relaxation and concentration a listening experience that is comfortable, pleasant, and relaxing a perception of the music in stereo an ability to use the device while carrying out normal tasks including listening to speech Sanctuary Device Usage Guidelines Use in situations that are impacted by bothersome tinnitus to obtain relief. Use at a volume level that is comfortable while still providing maximum relief from tinnitus. Use more volume for relief if needed, while still using a volume that is comfortable, pleasant, and relaxing. Place the music in the background of awareness and avoid tuning in to tinnitus during a listening session. Reduce listening volume a few minutes before ending a listening then, remove in an environment that is not completely quiet. 9

10 Relief Contrast A Common Perception Tinnitus is more noticeable after listening session due to the contrast from experiencing relief with device. Perception is short-term Strategies to minimize relief contrast Advise patient to decrease volume for 5-10 minutes prior to ending session- think of putting the tinnitus on a dimmer switch with a gradual reintroduction of the tinnitus to help transition from the relief the device provided Advise patient to remove device in an environment that is not completely quiet Contraindicated Activities Device cannot not be used: When patients are straining to hear While exercising strenuously While watching TV (with audio) While driving When the device can get wet Additional Counselling Points Conditions that may temporarily make tinnitus perception worse: Recent cold, flu, allergy, Eustachian tube dysfunction, excessive ear wax New medication, or changed dose of existing medication Excessive noise exposure Extended periods of straining to hear clearly Period of acute stress 10

11 Clinic Resources Fitting Criteria User Protocol Warranty, Loss and Damage Terms and Conditions of Sale Service and Repair Policy Receive an electronic copy Hard copy shipped with first order Patient Supplemental Materials Patient Education handbook Tinnitus Management Handbook Tips for success Follow up Considerations Suggested follow-up: One week post fit call Four week post fit check Patient needs Clinical judgment Follow-up documents TRQ, Patient feedback form Patient goals: Sense of control Relief while wearing the device Comfortable listening experience Patient fees Per visit model 11

12 The Neuromonics Sanctuary Tinnitus Management Tool Mild-to-moderate tinnitus disturbance TRQ score <35 Customized stimulus Same day fitting Thank you for your time and attention! 12